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Sr Medical Director
Utilization Management, M.D. or D.O. Required
Posted on 1/25/2023
Locations
Des Moines, IA, USA
Experience Level
Entry
Junior
Mid
Senior
Expert
Desired Skills
Management
Requirements
  • M.D. or D.O. degree
  • Active and unrestricted license to practice medicine in Iowa and/or South Dakota is required within 3 months from date of hire OR an administrative license; must be licensed in the state in which you reside. In the meantime, while obtaining license, the incumbent will participate in training, provide operational guidance and advice, and participate in projects as assigned while licensure is pending approval
  • Current Board Certification approved by the American Board of Medical Specialties, American Osteopathic Association, or National Board of Physicians and Surgeons
  • 3-5 years of clinical experience with 3+ years clinical utilization management experience in managed care, in a Medicare Advantage or Commercial environment,andsufficienttoenablecandidatetomakemedicaljudgmentsastoappropriatenessofcareandmedicalnecessity
  • Demonstrated leadership experience, including building/developing high performing teams. Establishes clear goals/expectations and motivates teams to achieve success
  • Previous administrative medical experience-e.g., clinical coordination, medical consulting, medical director (health plan, provider group, hospital group), etc. Strong preference for prior medical director or similar experience at a health plan
  • Understanding of the health care delivery system including, but not limited to, familiarity with outpatient facility and inpatient care business models including reimbursement
  • Expertise in leveraging industry knowledge, technical expertise, and relationship building skills to quickly build rapport, credibility, and collaborative partnerships with clinical peers, leaders, and stakeholders; applies skillful consulting abilities to influence corporate decisions
  • Very strong change management skills. Creates a clear view of future state and inspires others to advance the vision
  • Success mentoring and working within teams, including sharing accountability, influencing without direct authority, effectively listening to others, and effectively leading cross-functional teams to deliver results
  • Ability to make evidence-based decisions and review past history, benefit information, applicable policies, and other data to make sound, informed decisions in a timely manner
  • General understanding of medical policy development, including the need as a health insurer to establish a balance within policy of the appropriate level or care for an individual and the overall population of covered members
  • Proficiency with Microsoft Office applications - e.g., Word, Outlook. Demonstrated domain knowledge and ability to be conversant with interpretation and application of data and analysis at the highest level and broadest scope. Possess superior analytical skills
  • Board certified in Internal medicine
  • Experience working in a Hospitalist capacity
  • Involvement in transformational health care initiatives/projects
Wellmark

1,001-5,000 employees

Mutual insurance provider
Company Overview
Wellmark’s mission is to provide a broad array of high quality, accessible, affordable, and cost competitive health insurance products and services. The company is committed to delivering affordable and sustainable healthcare options by collaborating with various health-care partners to ultimately deliver a greater quality of health and life to future generations.
Benefits
  • Medical and prescription drug coverage
  • Dental coverage
  • Vision plan
  • Compensation: comprised of two components: base pay or annual salary, and potential pay from the Performance Incentive Program (PIP), awarded annually when financial and customer measures are successfully achieved.
  • Financial Benefits: competitive financial benefits through a generous 401(k) savings and investment plan.
  • Educational assistance
  • Pathways to Wellness incentives
  • Employee Assistance Program
  • Time off
Company Core Values
  • Use your strengths
  • Develop your story
  • Focus your health